Form I-912P HHS Poverty Guidelines for Fee Waiver Request

2012 HHS Poverty Guidelines* $16 755 $22 695 $28 635 $34 575 $40 515 $46 455 $52 395 $58 335 Add $5 940 for each $19 290 $26 115 $32 940 $39 765 $46 590 $53 415 $60 240 $67 065 Add $ 6 825 for each $20 955 $28 380 $35 805 $43 230 $50 655 $58 080 $65 505 $72 930 Add $7 425for each * These poverty guidelines remain in effect for use with Form I 912 Request for Fee Waiver from February 6 2012 until new guidelines go into effect in 2013 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 150% of HHS Poverty Guidelines* 150% of HHS Poverty Guidelines* additional person additional person Department of Homeland Security U S Citizenship and Immigration Services For Alaska: For Hawaii: For the 48 Contiguous States the District of Columbia Puerto Rico the U S Virgin Islands Guam and the Commonwealth of the Northern Mariana Islands: Form I 912P 02/06/12 N Household Size Household Size I 912P 2012 HHS Poverty Guidelines for Fee Waiver Request